Provider Demographics
NPI:1811523087
Name:BERNARD, CHANTELLE ELAM (EDD)
Entity type:Individual
Prefix:DR
First Name:CHANTELLE
Middle Name:ELAM
Last Name:BERNARD
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4860 COX RD STE 200
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-9248
Mailing Address - Country:US
Mailing Address - Phone:804-747-1922
Mailing Address - Fax:804-747-6182
Practice Address - Street 1:4860 COX RD STE 200
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-9248
Practice Address - Country:US
Practice Address - Phone:804-747-1922
Practice Address - Fax:804-747-6182
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0701008688101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0701008688OtherVA LICENSE NUMBER